Impact of Repeated Non-Fatal Infections on Quality of Life and Graft Function in ABO-Incompatible Kidney Transplants

Kidney transplantation (KT) is the preferred treatment for kidney failure, with living donor KT (LDKT) offering better outcomes and improved quality of life (QOL) than deceased donor KT. ABO incompatibility (ABOi) once restricted LDKT, but desensitization protocols now enable ABOi LDKT, expanding the donor pool with favorable outcomes. However, added risks of ABOi remain debated. We examined the impact of repeated infections on graft loss and death in both ABO-compatible (ABOc) and ABOi LDKT recipients.

Retrospective, nationwide Swiss Transplant Cohort Study from May 2008 to December 2022, including all ABOi LDKT patients. Clinically relevant infections (viral, bacterial, fungal, and parasitic) were analyzed as repeated adverse events.

Among 227 ABOi LDKT and 1172 ABOc recipients, 13% (183/1399) had ≥ 2 significant infections within the first 6 months. ABOi was independently associated to a higher infection risk (HR 1.21, 95% CI 1.10-1.34, p < 0.001). Patients with early recurrent infections were older, often female, and had ABOi LDKT. Patients with ≥ 2 infections faced increased risks of graft loss, lower eGFR, and reduced QOL.

ABOi LDKT patients face a higher risk of recurrent infections, especially within 6 months post-KT, associated with reduced allograft function and lower QOL.